Saving Lives in Sierra Leone (SLiSL) III Consortium Programme

This approach combines routine supervision with mentoring, data verification, problem-solving, and performance monitoring across various service areas.  

By enabling district and facility managers to regularly engage with frontline workers, identify gaps, and provide real-time guidance, visits foster accountability, continuous learning, and improved service delivery. It encourages teamwork, strengthens communication, and ensures that national standards are consistently applied.  

SLiSL-3 provides both financial and technical support to facilitate this cost-effective, scalable solution to improving health system performance and patient outcomes. SLiSL-3 participates in the ISS technical working group at the national level, contributing to the review of the ISS policy. At the district level, SLiSL-3 provides logistics support for supervisors to visit their designated facilities.

Working in close collaboration with the National RMNCAH+N to improve the percentage of reported maternal deaths investigated within 48 hours and subsequently reviewed in an MPDSR committee meeting not later than 30 days of incident occurrence. Conducting early MPDSR investigations and review meetings is essential for identifying causes, gaps and delays that contribute to maternal and newborn deaths in Sierra Leone.

Between inception and July 2025, SLiSL-3 has supported 62 MPDSR meetings across the six districts. 169 investigations were conducted within 48 hours of reported death, and 78 deaths were reviewed within 30 days. 

To strengthen clinical practice and improve the quality of care at both primary and secondary levels, SLiSL-3 has implemented the Sierra Leone Early Warning Scores (SLEWS) tool to enhance patient monitoring, facilitate early identification of clinical deterioration, and support timely escalation of care. As of July 2025, 348 clinicians have been trained on SLEWs across the 6 supported districts.  

SLiSL-3 support to the MOH has moved beyond specific clinical content training to how this training is delivered. District Education Teams have been established alongside the implementation of a Leadership in Education programme that teaches adult learning theory, facilitation, feedback, and educational governance. As of July 2025 40 educators have been trained across the district Education Teams and 30 educators completed Leadership in Education training in Kenema and and Kambia.

The intervention will be implemented through a structured cascade mentorship model using a hub-and-spoke approach across the 6 supported districts. Hospital-based mentors support CHC-level peer mentors, who in turn extend support to CHPs and MCHPs.

Blood transfusion services in Sierra Leone face challenges including limited blood donations, inadequate testing facilities, poor storage infrastructure, and a lack of trained personnel. Safe blood is essential for managing complications like postpartum haemorrhage, a leading cause of maternal mortality. Investing in safe, accessible blood supply is critical to improving maternal health outcomes nationwide. 

SLiSL-3 supports regular blood donation drives and the promotion of rational blood use to address these gaps. Since inception, the programme has supported 31 blood drives resulting in the collection of 1,123 pints of blood.

Family planning indicators in Sierra Leone remain low, with a modern contraceptive prevalence rate of around 22% among married women. High unmet need, limited access, and misconceptions contribute to frequent unplanned pregnancies, increasing maternal and child health risks. Adolescent fertility is also high, leading to complications in young mothers and poor neonatal outcomes. Gaps include weak supply chains, limited method choices, inadequate community outreach, and cultural barriers.  

SLiSL-3 adopts a two-pronged approach to improving access to family planning services, combining behaviour change communication with improved quality of family planning service delivery. These approaches are aimed at strengthening community-based services, ensuring consistent contraceptive supply, training health workers, and enhancing public education on family planning. 

SLiSL-3 supported FP outreaches aim to improve access and awareness in hard-to-reach areas. Between October 2024-July 2025, awareness-raising and mobile service delivery has contributed to 15,801 clients taking up a modern contraceptive method.

Nutrition and dietary diversity for pregnant women, lactating mothers, and children remains poor due to food insecurity, low income, limited nutrition education, and cultural feeding practices. Many households rely on starchy staples with insufficient intake of protein, fruits, and vegetables. Gaps include weak nutrition services at health facilities, limited community outreach, and inadequate micronutrient supplementation. 

SLiSL-3 supports priority areas through its cooking demonstrations and backyard gardens interventions. Cooking demonstrations are led by the District Nutrition Officer demonstrating safe food handling, processing and preparation of nutritious meals using locally available ingredients. Backyard gardens compliment this effort, by providing a long-term solution for increasing access to diverse, home-grown foods. SLiSL-3 provides households with seedlings and technical support to help them establish and maintain their gardens. Follow-up visits by district teams focus on crop care, fencing, and garden maintenance.

Since inception, 916 caregivers and mothers have participated in nutrition sessions, while more than 57 community health facilities have supported households in establishing backyard gardens.

SLiSL-3 introduced the CRADLE Vital Signs Alert device across supported health facilities to enhance the early detection of hypertensive disorders in pregnancy, particularly pre-eclampsia, and enables timely referral and management of high-risk cases. 

Ir also supports peer mentoring and referral tracking, ensuring that warning signs were interpreted correctly and followed by prompt clinical action. 

So far 888 devices have been distributed to 148 facilities and 1,641 frontline clinical staff have been trained across the supported districts. During this time 40% of documented referrals have been triggered by alerts from the device.

SLiSL-3 uses community outreach, community engagement and radio programming as vital tools for promoting health across Sierra Leone, especially in rural and underserved areas. 

• Community outreaches raise awareness and improve access to services.
• Community engagement ensures local voices are heard, builds trust, and strengthens public participation.
• Radio has a wide reach and accessibility, making it an effective platform for disseminating accurate health information, raising awareness on key health issues, and encouraging positive behaviour change. 

During disease outbreaks, such as Ebola or COVID-19, these approaches were crucial for timely information sharing, dispelling misinformation, and promoting preventive actions. Together, they enhance resilience, early response, and community ownership of health interventions, improving overall health outcomes. 

Gaps in health rights and literacy persist due to limited public awareness, low education levels, and inadequate community engagement. Addressing these gaps is crucial for empowering communities, promoting informed decision-making, and ensuring equitable access to care. In order to address this issue, SLiSL-3 is working with the MOH to establish Feedback Complaint Response Mechanisms (FRCM) that allow patients and communities to voice concerns, report issues, and suggest improvements in health services.

Through SLiSL-3 support, a toll free FRCM line was set up and 82 staff trained at the district level to receive complaints and channel them to the right authorities for redress. This mechanism has been used to enhance accountability, builds trust, and ensure services are responsive to user needs. Additionally, community meetings and radio platforms were used to inform and raise public awareness about patient’s rights, how to raise complaints and availability of services.

A gender assessment was also conducted to inform a gender-focused design and implementation of the SLiSL-3 programme. 

The health system faces gaps in data use and management, including incomplete reporting, limited data analysis skills, weak digital infrastructure, and poor data-driven decision-making. These issues hinder effective planning, resource allocation, and service delivery. 

Strengthening data systems is vital for evidence-based interventions and improved health outcomes nationwide. Hence, SLiSL-3 facilitated regular district level data review meetings.

Current gaps include limited awareness of safeguarding policies, weak reporting mechanisms, inadequate staff training, and a lack of clear accountability structures. These issues contribute to the underreporting of abuse, neglect, and exploitation, especially among vulnerable groups such as women, children, and persons with disabilities. 

Strengthening protection and safeguarding at the MOH and facility levels is critical to ensuring a safe, respectful, and rights-based healthcare environment. 

SLiSL-3 supported the MOH to address these gaps by establishing and launching the Safeguarding Community of Practice (CoP). Plans are now underway to establish a Safeguarding & GBV dashboard for real-time monitoring. 

Additionally, all SLiSL-3 consortium partners underwent safeguarding system assessments to pinpoint strengths and gaps, and tailor their training and technical support based on their needs. 58 District safeguarding focal points across all 6 supported districts completed basic training on safeguarding principles and safe referral pathway. 

Addressing these issues within the DHMT’s is vital to strengthen health system performance, improve service delivery, ensure efficient resource use, and support the effective implementation of national health policies at the local level.

SLiSL-3 works closely with the DHMTs to coordinate PHU in-charges meetings which serve as platforms for reviewing RMNCAH service delivery data, tracking maternal deaths, strengthening Mpox surveillance, and addressing operational bottlenecks. PHU staff also received updates on programme priorities, service protocols, and emerging challenges, contributing to improved local leadership and accountability. 

District-level partner coordination meetings also focus on aligning supervision efforts, sharing data on family planning uptake, reviewing distribution timelines, and agreeing roles for supportive supervision and joint monitoring.